About the role
About Judi Health Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels. At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering
benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health . Location : Hybrid 3 days (offices in NYC, Denver, CO and Charlotte, NC area) Position Summary : The Senior Lead Payer Gateway Management oversees electronic healthcare transaction processing between payers, providers, clearinghouses, vendors, and internal TPA adjudication platforms. This role ensures accurate, timely, and compliant processing of HIPAA EDI transactions and hosted gateway solutions supporting claim submissions, eligibility verification, claims status checks, acknowledgments, rejections, file reconciliation, and production issue resolution. The Senior Lead serves as an operational and technical bridge across Claims, IT/EDI, Clearinghouse Operations, Provider Relations, Client Implementation, Vendors, and Compliance.
The role is accountable for transaction reliability, trading-partner readiness, file controls, root-cause remediation, and continuous improvement of gateway performance for medical claims administration. Position
Responsibilities : Oversee payer gateway and clearinghouse operations supporting HIPAA EDI transactions, including 837 claims, 270/271 eligibility, 276/277 claims status, 835 remittance/payment support, acknowledgments, rejects, and related file exchanges. Ensure claim submissions are routed, accepted, monitored, and reconciled timely to support accurate TPA adjudication and minimize provider abrasion, duplicate submissions, avoidable rejects, and processing delays. Manage daily operational controls for inbound/outbound files, transaction queues, acknowledgments, trading-partner responses, exception reports, file balancing, resubmission workflows, and aging items. Lead issue triage and root-cause analysis for transaction failures, clearinghouse rejects, payer/provider setup defects, connectivity issues, mapping errors, enrollment gaps, duplicate files, missing acknowledgments, or reconciliation breaks. Partner with IT/EDI, claims system teams, clearinghouses, vendors, and trading partners to define
